From the first consultation the relevance of the indication is confirmed, the operative planning is started, and a local assessment is carried out: it depends on the clinical circumstances.
In case of mastectomy, local examination eliminates the eventuality of local recurrence. If in doubt, or the existence of irregularities of the subcutaneous tissue, an ultrasound may be required. Any suspicious lesion must prove its benignity before reconstruction.
In case of sequelae of conservative treatment, it is necessary to have, at the initial consultation, the result of the pathology. The risk of coinciding with a new breast cancer or a local recurrence of the first cancer is not negligible in this situation. The protocol must be very strict in order to limit this risk of coincidence. The protocol includes a precise breast imaging assessment, with mammographic, ultrasound, and MRI assessment, done by a radiologist specializing in breast imaging. Lipomodeling is usually performed after having been agreed by the specialized radiologist, and also by the oncologist who follows the patient (who has most often referred the patient for the correction of the after-effects of conservative treatment). Similarly, one year after the intervention, we perform a new breast imaging assessment with mammography and ultrasound; in the case of any suspicious image, a microbiopsy is performed by the radiologist.
In the context of breast aesthetic surgery, the spontaneous risk of breast cancer is evaluated for each patient (overall: the annual risk of breast cancer is mainly a function of the age of the patient, and is 1/3520 at 22 years, 1/720 at 40 years, 1/370 at 50 years, 1/350 at 60 years, 1/310 at 70 years). A precise breast imaging assessment, with mammographic and ultrasound evaluation, done by a radiologist specialized in breast imaging is necessary with age-dependent examinations of the patient (ultrasound before 30 years of age, 1-incidence mammogram and ultrasound between 30 and 40 years of age, and a 2-incidences mammogram and an ultrasound after 40 years of age). Lipomodeling is usually performed after the specialized radiologist has agreed to it within a multidisciplinary approach (it is desirable that the radiologist be familiar with this subject; that’s why, every two years, we organize specialized training for radiologists interested in breast imaging – See the Teachings and Conventions section of my main website). Similarly, one year after the procedure, the patient agrees to have the same imaging of the breast done by the same radiologist.
Patients are informed about the surgical procedure, as well as potential risks and complications. An information sheet is given to the patient. We have 4 different information sheets: lipomodeling in breast reconstruction, lipomodeling for the correction of the sequelae of conservative treatment of breast cancer, lipomodelage for the correction of breast malformations, and aesthetic lipomodelling of the breast or lipoaugmentation or lipofilling of the breast or breast lipostructure or adipose tissue autograft.
It is important that the patient is at her equilibrium weight +++ at the time of the intervention because the transferred fat keeps the memory of her place of origin (if the patient loses weight after the intervention, she will lose a part of the benefit of the intervention).
It is necessary to evaluate the areas that are to be treated on the breast. They are spotted and marked on the patient. Photographs are systematically taken that will allow to prepare the intervention the day before, and serve as a reference point to evaluate the effectiveness of the intervention on the donor zones, and on the receiving site. The study of the various fatty zones of the body is carried out in a complete way in order to identify the natural steatomeries: in accordance with the patient the choice is made between the abdominal steatomery, which does not require a change of position operative; and the trochanteric region (“saddlebags”) and the inner thighs and knees. The contours of the donor sites are drawn with a dermographic pencil before the procedure.